Apply to become an Instructor

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Creative Beauty Academy

Instructor Application

Position Applying For: *

Legal First Name *

Legal Last Name *

Preferred Nick Name (Optional)

Social Security Number *

Date of birth *

Phone *

Email *

Your Website *

Gender (For Insurance coverage only) If Other leave blank

Male

Female

How did you hear about us? *

Walk In/Friend

Google

Facebook

Other

DPOR License Number *

Other DPOR Licenses Held and License Number if Applicable *

State Drivers License Information *

State of Issue
License Number
Exp Date

Instructor Questionnaire

1. Have you ever had a license, certificate, permit, or registration to practice a regulated profession denied, conditioned, curtailed, limited, restricted, suspended, revoked, reprimanded, or disciplined in any way? *

Yes

No

2. Have you ever been permitted to resign or surrender your license, certificate, permit, or registration to practice in a regulated profession while under investigation or while action was pending against you by any professional licensing agency or criminal or administrative jurisdiction? *

Yes

No

3. Are you currently under investigation or is any disciplinary action pending against you now by any local, state or federal licensing, enforcement or regulatory agency? *

Yes

No

4. Have you ever been declared by any court to be incompetent by reason of mental defect or disease and not restored? *

Yes

No

5. Have you ever had a documented case in which you were involved as the abuser in any incident of verbal, physical, mental, or sexual abuse? *

Yes

No

6. Have you been terminated, suspended, reprimanded, sanctioned, or asked to leave voluntarily from a position because of drug or alcohol use or abuse within the past five (5) years? *

Yes

No

7. Have you ever been subject to a disciplinary action taken by any (including Virginia) local, state or national regulatory body? *

Yes

No

8. Have you ever had an application for licensure, certification or registration as a practitioner or instructor in the fields of barbering, cosmetology, waxing, nail care, esthetics, body-piercing, or tattooing denied by any (including Virginia) local, state or national regulatory body? *

Yes

No

9. Have you ever been convicted or found guilty, regardless of the manner of adjudication, in any jurisdiction of the United States of any felony within the last 20 years? Any plea of nolo contendere shall be considered a conviction. *

Yes

No

10. Have you been convicted or found guilty, regardless of the manner of adjudication, in any jurisdiction of the United States of any misdemeanor involving moral turpitude, sexual offense, non-marijuana drug distribution or physical injury within the last two (2) years? *

Yes

No

By signing this application, I certify the following statements: I am aware that submitting false information or omitting pertinent or material information in connection with this application may lead to denial of employment. I authorize the Creative Beauty Academy to verify information concerning me or any statement in this application from any person, or any source we may contact. I also agree to present any credentials or documents required or requested by the Creative Beauty Academy Adminssions Dept. I authorize any federal, state or local government agency, current or former employer, or other individual or business to release information which may be required for a background investigation. y I have read, understand and complied with all the laws of Virginia related to this profession under the provisions of Title 54.1, Chapter 7, of the Code of Virginia and the Virginia Board for Barbers and Cosmetology. *

Yes

No

Agree By Typing Your Name *

First Name
Last Name
Date

I agree to terms & conditions provided by the company. By providing my phone number, I agree to receive text messages from the Creative Beauty Academy and Partner Companies.

Contact: 703-782-4714

Address: 7500 Diplomat Drive #201

Manassas, VA 20109

Support@creativebeautyacademy.com

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